04/18/2016    Arnold B. Wolf, DPM

The Economics of the New Healthcare Era: Part 1 - What Has Been Happening?

As I read Dr. Hrywnak's initial post, I asked
myself, "What world am I living in"? With no
personal offense intended, it is my observance
that there are those that believe that once
statistical models are created, they must all,
in fact, be true. In point of fact (and in
agreement with all the other contrarians who
have posted to this conversation), it is my
belief that healthcare in the United States, as
a whole, is deteriorating. I submit the
following for consideration:

1) The ACA was supposed to enhance the
portability of medical information. If our
government had any common sense, one
information platform would have been selected
(after thorough testing) so that all provider
could have easy access to that data source,
thereby avoiding potential inefficiencies
(redundant testing, procedures and so on).

2) More time is required to process patients.
Have we seen a reduction in payroll costs and
equipment expenditures because of the ACA?
Whereas MU and PQRS may provide higher level of
data for those that make their career out of
looking at that information, the process time
at ground level has increased. That drives
payroll costs up and takes away from time spent
treating the patient.

3) Forced conversion to ICD-10-What genius went
in this conversion? The time required to
process claims has "ramped up" considerably
because of the "illogical transition" from ICD-
9. Why is it that we must change because the
rest of the world is using ICD-10? The last
time I checked, The United States never
converted to the metric system, and, we're
doing just fine! Let us not forget the
constant changing landscape of claims
submission beyond ICD-10. Successful medical
claims submission should not be about "knowing
the tricks of the trade". Instead, it is about
making the process so complicated that claims
do not get paid. Insurance companies do not
want to pay physicians and, it is readily
apparent that they want to pay us less. They
obviously have a better seat at the table than
"we" do.

I could continue, but these 3 brief comments
illustrate my point. Our government is
inefficient and to think they could create
efficiencies elsewhere is preposterous. As
physicians, we are forced to spend more time
"treating the computer" instead of the patient.
In point of fact, we are forced to be
inefficient (despite our best efforts). I would
submit, that those of us that still treat
patients (and not create/study analytical
models) are participating in a system that is
doomed to fail. In closing, Physicians are
acting like the Jews in Nazi Germany...If we
all behave and get on the train, we'll be
OK...until we see where the train ends up!

Arnold B. Wolf, DPM Sterling Heights, MI

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04/16/2016    David Gurvis, DPM

The Economics of the New Healthcare Era: Part 1 - What Has Been Happening? (Bryan C. Markinson, DPM)

I am in complete agreement with Dr. Markinson.
I was dismayed and outraged by Dr. Hrywnak’s
remarks. Some seem to have swallowed the hook,
the sinker, the float, and are still going.
How can we have come so far downhill? Is this
kind of crap going to hit us and hit us hard?
Sure. But as they say, do we have to enjoy it
and embrace it?

EMRs have done nothing good except build a
tower of Babel. Yet some rave about how much it
has improved medicine. If it has improved
anything, it is in the attorney’s ability to
sue.

PQRS? Improved quality? Balderdash is the
strongest word I am going to use here, but I
could do better (but would never get
published). MU? To whom? Physicians now spend
on average an hour a day looking at emails and
if my own PCP is any example, most of them
crap. Not at all helpful to treatments and
needing more explanation back to the patient
than can effectively be done in a simple email.

I used to take notes on paper with an
instrument that needed very little instructions
after grade school. You might recall it, it is
called a ball point pen. Instead people now
brag about having scribes. Another employee.
And we discuss which reporting agency is best
for the PQRS (at what cost added to our
practices), instead of say, discussing some
interesting case.

There is a ICD 10 code and I shall quote it
Insect bite (non-venomous) of anus (initial
encounter) S30.867A. The only question left to
ask is “are we the anus”? And why?

David E Gurvis, DPM, Avon, IN